What are the alternatives to knee replacement surgery?

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Most doctors recommend non-surgical (conservative) treatments before considering a knee replacement, including:

  • diet – losing weight will reduce the strain on your knee
  • exercise – even though this may be difficult because of the pain, there's usually some form of non-impact exercise (for example swimming or cycling) that you can start gently and which will improve the strength and flexibility of your knee
  • drugs – painkillers can reduce the pain in your joint, while non-steroidal anti-inflammatory drugs (NSAIDs) may help if your knee is swollen.

Generally these don’t provide such good results as a new knee joint but they may allow you to delay having a knee replacement operation for some years. If you’ve tried these options, you may want to think about the surgical alternatives to knee replacement:

Arthroscopic washout and debridement

Keyhole surgery techniques (arthroscopy) can be used to smooth damaged cartilage and remove debris from the knee joint. It's no longer recommended if you have arthritis where the cartilage has worn away so that bone is rubbing against bone. However, there’s some evidence that it can be useful for younger patients with less advanced arthritis, especially if there are loose fragments of bone or cartilage in the knee which can cause it to lock or give way.

Microfracture

This operation, which is performed by keyhole surgery, involves making holes in exposed bone surfaces with a drill or pick, which encourages new cartilage to grow from the bone marrow. The technique isn’t recommended for advanced arthritis.

Osteotomy

This involves cutting the shin bone crosswise, creating a wedge to shift the load away from the area affected by arthritis. Osteotomy may be considered as a way of putting off a knee replacement operation. However, it can make it more difficult to carry out a successful total knee replacement later on – especially if during the osteotomy the surgeon has to cut through an important ligament on the inner surface of the knee (the medial collateral ligament). A rare type of this operation is osteotomy of the end of the thigh bone to shift load inwards if the outer part of the knee is affected by arthritis.

Autologous chondrocyte therapy (ACT)

If only the hard cartilage is damaged, new cartilage can be grown in a test tube from your own cells. The new cartilage is then applied to the damaged area. This method is mainly designed to repair small areas of cartilage damage resulting from accidental injury to the knee joint. It isn’t yet proven for arthritis and would
only be suitable for younger patients whose cartilage cells are more active. It's usually therefore only done as part of a research trial, as are newer techniques using stem cells.

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